Almost all stakeholders and interviewees consulted during the course of the evaluation reported that the Better Access initiative had improved access to mental health services across all population groups in the community. This is supported by Medicare data reporting the growth in the number of services funded through the Better Access initiative (see figure 1).
Figure 1 is based on Medicare Australia data and demonstrates continuing high rates of growth for services provided by GPs, psychologists and clinical psychologists. For and GPs, there was a 300 per cent increase in the number of services funded between November 2006 and September 2009. This increase is artificially inflated as GPs have been the predominant provider of mental health services in the community for many years and much of the identified increase may reflect utilising the newly available specific item number for mental health services, instead of previously utilised general item numbers.
Nearly all psychiatrists providing responses perceived the new MBS items as an effective means to encourage psychiatrists to accept new referrals and as supporting their tertiary assessment and consultation role. A number of psychiatrists reported setting aside regular appointment slots for new referrals. A number of GPs also reported a perceived improvement in access to psychiatrists as a result of the Better Access initiative. Unfortunately most GPs, AHPs and consumers also reported that it still remained difficult to access psychiatrists, particularly for patients who needed to be 'bulk billed or charged a reduced fee. This was perceived to be a result of a general shortage of psychiatrists. In some areas where the uptake of the item numbers was supported there was a greater shift in psychiatry work practices increasing the number of new patients able to benefit from psychiatric input into their care. (UPASA in SA; GLAS in Brisbane)
GPs also reported that the new MBS items provided a more adequate remuneration for the time spent providing mental health services and that they were now doing more mental health work than ever before. Overall, the Divisions of General Practice reported that the Better Access initiative was well established and strongly supported by GPs, particularly in relation to the capacity to refer patients to allied health providers to receive focussed psychological strategies. Though most GPs were strongly supportive of Better Access, a number thought that there was scope to further improve access by continuing to enhance GP awareness of the Better Access initiative and their skills in mental health diagnosis and preparing mental health treatment plans.
The growth in services provided by general psychologists is similar to that for psychiatrists and GPs. Prior to the Better Access initiative, Medicare funding was limited to services provided through ATAPS and MAHS11, both of which had capped budgets administered by the local Division of General Practice. Separate funding of clinical psychologists is a new item number within the Better Access initiative.
Prior to the Better Access initiative, Medicare funding for mental health services (with the exception of MAHS) was not available to social workers and occupational therapists. The relatively low growth in services provided by these professions is most likely reflective of the relatively small number of providers in private practice.
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Most AHPs interviewed (predominantly psychologists) when commenting on the high rate of growth in services indicated in Figure 1 thought that the level of growth was unsurprising and that it would continue to increase as a result of high levels of unmet demand in the community, more practitioners entering the market, increasing GP and consumer awareness further driving demand and referral networks expanding and becoming more established .
All stakeholders and interviewees were unanimous in reporting a real increase in the number of people receiving allied health services through the Better Access initiative. Though it was noted that some of the service increase would comprise pre-existing clients of established AHPs now claiming the MBS rebate (i.e. people who were receiving or would have received services without the Better Access initiative), the effect of any shift in billing arrangements was perceived as relatively minor.
Children were reported by GPS, AHPS and consumers as one group most benefiting from improved access to mental health services as a result of the Better Access initiative, though opportunities to further improve access and outcomes for children were also noted. AHPs also reported that increasing numbers of men and older people were accessing the services as awareness increased and stigma associated with accessing mental health services decreased. The later factor was seen by many AHPS and consumer representatives to be a result of wider mental health promotion strategies (such as awareness and prevention strategies around depression) leading to greater understanding of mental health issues in the community and local networks of knowing people who have used and found mental health services useful – 'word of mouth' referrals. AHPs also reported an increasing complexity of individuals accessing the service as referral networks with GPs strengthened.
Although improved access was reported throughout the consultation process, a number of inequalities in access to services were identified. Disparities in access were reported in relation to people living in rural and remote communities, people living in low socio economic communities, children and young people, older persons, Aboriginal and Torres Strait Islander people, and people from culturally and linguistically diverse backgrounds. For many of these groups affordability of gap payments remained an issue. GPs and AHPs working with clients from these groups also identified that longer time periods required to engage with clients, family, carers and the broader community and higher likelihood of missed appointments as a result of affordability and other challenges the individual patient may experience (for example distance, access to transport, other comorbidities) limited the commercial viability of working with these populations. In respect to children, many respondents working with children noted that the lack of an MBS rebate to provide family therapy or see families and/or carers without the child being present limited the scope of work that could be done with children.
The areas of inequality most noted by interviewees consulted related to people living in rural and remote communities, culturally and linguistically diverse communities and low socio-economic communities. The small number of practitioners in remote areas reported that access to mental health services in these communities may have decreased as a result of the increased financial viability of private practice in metropolitan and regional areas reducing the number of AHPs who may have otherwise worked in remote communities through ATAPs.
Access to mental health services by Indigenous Australian received very little comment by participants in the consultations. Though several psychologists reported successful interventions based on the provision of secondary consultation services to local Aboriginal Health Workers, these were not funded through the Better Access initiative. Of those commenting on access by Aboriginal and Torres Strait Islander people, it was generally believed that services for these communities may be more appropriately funded through alternative programs such as Better Outcomes or Aboriginal and Torres Strait Islander health services.
Figure 1: Number of MBS Better Access items processed by month, September 2005 to September 2009
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Text version of Figure 1Figures in this description are very approximate as they have been read from the graph.
This graph shows Better Access items processed for psychiatrists, general practitioners, clinical psychologists, psychologists, social workers and occupational therapists per month.
Items processed for:
- psychiatrists have risen very gradually between September 2006 and December 2009, remaining consistently below about 10,000.
- psychologists have risen in a fluctuating manner from 0 in September 2006 to over 150,000 in September 2009.
- general practitioners have risen in a fluctuating manner from about 39,000 in December 2006 to about 150,000 in September 2009.
- social workers have risen very gradually from 0 in December 2006 to about 17,000 in September 2009.
- clinical psychologists have risen in a fluctuating manner from 0 in December 2006 to about 90,000 in September 2009.
- occupational therapists have risen very gradually from 0 in December 2006 to about 3,000 in September 2009.